Cardiovascular Pharmacology: Open Access

Echocardiographic assessment of the proximal aorta after tetralogy of fallot repair

11^th World Congress on Pediatric Cardiology and Congenital Cardiovascular Disease

April 18-19, 2017 London, UK

Cristina Cruz, Teresa Pinho, Claudia Camila Dias, Jose Silva Cardoso and Maria Julia Maciel

Saint John Hospital, Portugal
University of Porto, Portugal

Posters & Accepted Abstracts: Cardiovasc Pharm

Abstract:

Background: An intrinsic aortopathy can lead to aortic (Ao) dilatation late after tetralogy of fallot (ToF) repair. Its extension and prevalence is not clearly defined. Objectives: We aimed to compare the proximal aorta dimensions and elasticity assessed by transthoracic echocardiography in ToF and normal controls, and to find possible predictors of Ao dilatation. Methods: We included 127 consecutive adults after ToF repair and 63 sex- and age-matched healthy controls. We estimated the Ao z-score at the level of the sinuses of Valsalva (SoV) and ascending aorta (AAo) and defined Ao dilation for a z-score >2. We assessed Ao strain, distensibility and stiffness index by transthoracic echocardiography using accepted formula. Results: One hundred-twenty seven patients (pts) (mean age 30±9 years; 52% males) had a mean follow-up time since ToF repair of 23±7 years. In 59 cases, an aortopulmonary shunt was done prior to repair, with a median interval of 3 years. In 57 patients complete repair used a transannular patch. A right Ao arch coexisted in 29 cases. The prevalence of SoV and AAo dilatation were 29.9% and 23.8%, respectively. No differences were found between ToF pts and controls regarding systolic blood pressure and pulse pressure. ToF pts had a bigger Ao z-score (1.4±1.2 vs. -0.6±1.2, P<0.01 and 1.2±1.1 vs. -0.7±0.7, P<0.01, at the level of SoV and AAo, respectively), lower Ao strain [6.9 (2.6-61.5) vs. 15.4 (3.7-45.0), P<0.01] and distensibility [1.4 (0.4-1.4) vs. 3.7 (0.1-1.4) KPa-110-3, P<0.01], and a higher Ao stiffness index [7.4 (0.8-23.6) vs. 3.1 (0.9-14.1); P<0.01]. There was a significant positive correlation between the Ao z-score and left ventricular (LV) mass and volumes indexed to body surface area (AAo z-score and LV mass index in Pearsonâ??s correlation (r)=0.26, P<0.01), Ao stiffness index and SAo (r=-0.21; P=0.007). By multivariate analysis, the sinotubular junction effacement was an independent predictor of AAo dilatation [odds ratio 4.1, 95% confidence interval (CI) 1.4-12.3, P=0.01]. Conclusion: It can be concluded that tetralogy of fallot patients have a bigger and stiffer ascending aorta, and transthoracic echocardiography can be used as a screening tool for this aortopathy.

Biography :

Email: mcristina.cruz@hsjoao.min-saude.pt